New perspectives on assessment and understanding of the patient with cranial bone defect: a morphometric and cerebral radiodensity assessment.

Background: Skull defects after decompressive craniectomy (DC) cause physiological changes in brain function and patients can have neurologic symptoms after the surgery. The objective of this study is to evaluate whether there are morphometric changes in the cortical surface and radiodensity of brain tissue in patients undergoing cranioplasty and whether those variables are correlated with neurological prognosis. Methods: This is a prospective cohort with 30 patients who were submitted to cranioplasty and followed for 6 months. Patients underwent simple head CT before and after cranioplasty for morphometric and cerebral radiodensity assessment. A complete neurological exam with Mini-Mental State Examination (MMSE), modified Rankin Scale, and the Barthel Index was performed to assess neurological prognosis. Results: There was an improvement in all symptoms of the syndrome of the trephined, specifically for headache (p = 0.004) and intolerance changing head position (p = 0.016). Muscle strength contralateral to bone defect side also improved (p = 0.02). Midline shift of intracranial structures decreased after surgery (p = 0.004). The Anterior Distance Difference (ADif) and Posterior Distance Difference (PDif) were used to assess morphometric changes and varied significantly after surgery. PDif was weakly correlated with MMSE (p = 0.03; r = -0.4) and Barthel index (p = 0.035; r = -0.39). The ratio between the radiodensities of gray matter and white matter (GWR) was used to assess cerebral radiodensity and was also correlated with MMSE (p = 0.041; r = -0.37). Conclusion: Morphological anatomy and radiodensity of the cerebral cortex can be used as a tool to assess neurological prognosis after DC.

Low-cost customized cranioplasty using a 3D digital printing model: a case report.

BACKGROUND: Cranial defects usually occur after trauma, neurosurgical procedures like decompressive craniotomy, tumour resections, infection and congenital defects. The purpose of cranial vault repair is to protect the underlying brain tissue, to reduce any localized pain and patient anxiety, and improve cranial aesthetics. Cranioplasty is a frequent neurosurgical procedure achieved with the aid of cranial prosthesis made from materials such as: titanium, autologous bone, ceramics and polymers. Prosthesis production is often costly and requires complex intraoperative processes. Implant customized manufacturing for craniopathies allows for a precise and anatomical reconstruction in a shorter operating time compared to other conventional techniques. We present a simple, low-cost method for prosthesis manufacturing that ensures surgical success. CASE PRESENTATION: Two patients with cranial defects are presented to describe the three-dimensional (3D) printing technique for cranial reconstruction. A digital prosthesis model is designed and manufactured with the aid of a 3D computed tomography. Both the data of large sized cranial defects and the prosthesis are transferred to a 3D printer to obtain a physical model in poly-lactic acid which is then used in a laboratory to cast the final customised prosthesis in polymethyl methacrylate (PMMA). CONCLUSIONS: A precise compliance of the prosthesis to the osseous defect was achieved. At the 6 month postoperative follow-up no complications were observed i.e. rejection, toxicity, local or systemic infection, and the aesthetic change was very significant and satisfactory. Customized 3D PMMA prosthesis offers cost advantages, a great aesthetic result, reduced operating time and good biocompatibility.

Aplasia cutis: revisão de literatura e relato de caso / Aplasia cutis: literature review and case report

Aplasia cútis congênita (ACC) é uma doença rara, caracterizada pela ausência de formação completa da pele. Geralmente ocorre no couro cabeludo, na linha mediana, e se apresenta ao nascimento como uma ferida que pode atingir diferentes profundidades e envolver o periósteo, crânio e dura-máter. Apresentamos dois casos de recém-nascidos com aplasia cútis congênita no couro cabeludo que foram tratados no Centro de Atendimento Integral ao Fissurado Lábio Palatal de Curitiba- Paraná. Devido à raridade da ACC e ao pequeno número de pacientes nas séries publicadas na literatura, a padronização do tratamento ainda é incipiente. O propósito do presente trabalho é realizar uma revisão da literatura sobre os aspectos epidemiológicos, diagnóstico e formas de tratamento da ACC de couro cabeludo.

Aplasia cutis congenital (ACC) is a rare disease characterized by the absence of skin formation. Usually occurs on the scalp, in the midline, and presents at birth as a wound that can reach different depths and can involve the periosteum, skull and dura. We present two cases of newborns with congenital cutis aplasia on the scalp that were treated at the Center for Integral Assistance of Cleft Lip and Palate Curitiba-Paraná. Due to the rarity of ACC and the small number of patients in published series in the literature, standardization of treatment is still a challenge. The purpose of this paper is to review the literature on the epidemiology, diagnosis and treatment modalities of ACC of the scalp.

CRANIOPLASTY FOR REPAIR OF CRANIOSCHISIS ASSOCIATED WITH MENINGOCELE IN A JERSEY CALF

Cranioschisis with meningocele at the parietal region was diagnosed in a 2-day-old calf. At presentation the animal was standing, attentive and had normal suckling reflex. However, an ovoid, soft, slightly lateral, bladder-like mass was observed extending from the intercornual protuberance to the insertion of the nuchal ligament. Physical examination and radiographs evidenced a deformity of the parietal bone and cranioplasty using a cartilage homograft was performed in an attempt to correct the bone defect. The calf did well postoperatively until day nine. However apathy and seizures were present from day 13 leading to death on day 15.

Cranioplasty for repair of cranioschisis associated with meningocele in a Jersey calf / Cranioplastia para o tratamento de craniosquise associada à meningocele em uma bezerra da raça Jersey / Craneoplastia para el tratamiento de craneosquisis asociada a meningocele en una becerra de la raza Jersey

Cranioschisis with meningocele at the parietal region was diagnosed in a 2-day-old calf. At presentation the animal was standing, attentive and had normal suckling reflex. However, an ovoid, soft, slightly lateral, bladder-like mass was observed extending from the intercornual protuberance to the insertion of the nuchal ligament. Physical examination and radiographs evidenced a deformity of the parietal bone and cranioplasty using a cartilage homograft was performed in an attempt to correct the bone defect. The calf did well postoperatively until day nine. However apathy and seizures were present from day 13 leading to death on day 15.

Foi diagnosticado craniosquise com meningocele na região parietal de uma bezerra de dois dias de idade. Na abordagem clínica inicial o animal estava em estação, atento e mamando normalmente. Porém, foi detectada à palpação uma massa ovoide, macia e levemente lateral, estendendo-se desde a protuberância intercornual até a inserção do ligamento da nuca. O exame físico e as radiografias evidenciaram um defeito do osso parietal pelo que foi realizada cranioplastia utilizando um enxerto homólogo de cartilagem na tentativa de corrigir a falha óssea. O animal teve evolução pós-operatória favorável até o dia nove. Entretanto, apresentou apatia e convulsões a partir do dia 13, o que o levou a óbito no dia 15 após a cirurgia.

Fue diagnosticada craneosquisis con meningocele en la región parietal de una becerra de dos días de edad. Durante el abordaje clínico el animal se encontraba en cuadripedestación, atento y mamando normalmente. Sin embargo, se detectó una masa ovalada, de consistencia suave y lateralizada, que se extendía desde la protuberancia intercornual hasta la inserción del ligamento nucal. El examen fisico y las radiografias permitieron la identificación de una falla en el hueso parietal por lo que fue realizada la craneoplastia utilizando un injerto homólogo de cartílago con la finalidad de corregir el defecto. El animal evolucionó favorablemente hasta el noveno día. Sin embargo, a partir del día 13 presentó apatía y convulsiones lo que provocó su muerte 15 días después de la cirugía.